Article Text

Original research
Description of symptom course in a telemedicine monitoring clinic for acute symptomatic COVID-19: a retrospective cohort study
  1. James B O'Keefe1,
  2. Elizabeth J Tong1,
  3. Ghazala D O'Keefe2,
  4. David C Tong3
  1. 1Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr James B O'Keefe; jbokeef{at}


Objective Describe the disease course in a cohort of outpatients with COVID-19 and evaluate factors predicting duration of symptoms.

Design Retrospective cohort study.

Setting Telemedicine clinic at a large medical system in Atlanta, Georgia.

Participants 337 patients with acute COVID-19. Exclusion criteria included intake visit more than 10 days after symptom onset and hospitalisation prior to intake visit.

Main outcome measures Symptom duration in days.

Results Common symptoms at intake visit are upper respiratory (73% cough, 55% loss of smell or taste, 57% sinus congestion, 32% sore throat) and systemic (66% headache, 64% body aches, 53% chills, 30% dizziness, 36% fever). Day of symptom onset was earliest for systemic and upper respiratory symptoms (median onset day 1 for both), followed by lower respiratory symptoms (day 3, 95% CI 2 to 4), with later onset of gastrointestinal symptoms (day 4, 95% CI 3 to 5), when present. Cough had the longest duration when present with median 17 days (95% CI 15 to 21), with 42% not resolved at final visit. Loss of smell or taste had the second longest duration with 14 days (95% CI 12 to 17), with 38% not resolved at final visit. Initial symptom severity is a significant predictor of symptom duration (p<0.01 for multiple symptoms).

Conclusions COVID-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Initial symptom severity is a significant predictor of disease duration for most considered symptoms.

  • COVID-19
  • telemedicine
  • primary care

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  • Contributors DCT had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Transparency statement—DT attests that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained. Concept and design—JBO, GDO and DCT. Acquisition, analysis or interpretation of data—JBO, EJT, GDO and DCT. Drafting of the manuscript—JBO, EJT and DCT. Critical revision of the manuscript for important intellectual content—JBO, EJT, GDO and DCT. Statistical analysis—DCT. Obtained funding—JBO.

  • Funding JBO is funded by the Georgia Geriatrics Workforce Enhancement Program (GA-GWEP) COVID-19 Telehealth award, supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of Award Number T1MHP39056 totalling $90 625 with 0% financed with non-governmental sources.

  • Dissemination declaration We plan to disseminate our results publicly but it would not be feasible to reach discharged patients with study results and therefore we do not plan to contact study participants for dissemination.

  • Disclaimer The contents are those of the author and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the US government. The funder/sponsor had no direct role in study planning and conduct, reporting or authorship. The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to (1) publish, reproduce, distribute, display and store the Contribution, (2) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or abstracts of the Contribution, (3) create any other derivative work(s) based on the Contribution, (4) to exploit all subsidiary rights in the Contribution, (5) the inclusion of electronic links from the Contribution to third party material wherever it may be located; and, (6) license any third party to do any or all of the above.

  • Competing interests All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work. GDO served on an advisory board of Eyepoint Pharmaceuticals in 2019. It is unrelated to the current work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Emory University Institutional Review Board (STUDY00000766), which granted both a waiver of informed consent and a waiver of the Health Information Portability and Privacy Act as the study posed no more than minimal risk.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Deidentified data are available for sharing upon reasonable request to DCT (ORCID 0000-0001-9761-6124). Data include patient demographics and comorbidities as well as symptom dates for all participants.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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